Extracorporeal Membrane Oxygenation for COVID-19: Comparison of Outcomes to Non-COVID-19-Related Viral Acute Respiratory Distress Syndrome From the Extracorporeal Life Support Organization Registry

Abhimanyu Chandel; Nitin Puri; Emily Damuth; Christopher Potestio; Lars-Kristofer N Peterson; Julia Ledane; Craig R Rackley; Christopher S King; Steven A Conrad; Adam Green

doi:10.1097/CCE.0000000000000861

Extracorporeal Membrane Oxygenation for COVID-19: Comparison of Outcomes to Non-COVID-19-Related Viral Acute Respiratory Distress Syndrome From the Extracorporeal Life Support Organization Registry

Crit Care Explor. 2023 Feb 3;5(2):e0861. doi: 10.1097/CCE.0000000000000861. eCollection 2023 Feb.

Authors

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
² Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ.
³ Department of Anesthesia, Cooper University Health Care, Camden, NJ.
⁴ Cooper Medical School of Rowan University, Camden, NJ.
⁵ Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Health System, Durham, NC.
⁶ Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA.
⁷ Departments of Medicine, Emergency Medicine, Pediatrics and Surgery, Louisiana State University Health Sciences Center, Shreveport, LA.

Abstract

To compare complications and mortality between patients that required extracorporeal membrane oxygenation (ECMO) support for acute respiratory distress syndrome (ARDS) due to COVID-19 and non-COVID-19 viral pathogens.

Design: Retrospective observational cohort study.

Setting: Adult patients in the Extracorporeal Life Support Organization registry.

Patients: Nine-thousand two-hundred ninety-one patients that required ECMO for viral mediated ARDS between January 2017 and December 2021.

Interventions: None.

Measurements and main results: The primary outcomes of interest were mortality during ECMO support and prior to hospital discharge. Time-to-event analysis and logistic regression were used to compare outcomes between the groups. Among 9,291 included patients, 1,155 required ECMO for non-COVID-19 viral ARDS and 8,136 required ECMO for ARDS due to COVID-19. Patients with COVID-19 had longer duration of ECMO (19.6 d [interquartile range (IQR), 10.1-34.0 d] vs 10.7 d [IQR, 6.3-19.7 d]; p < 0.001), higher mortality during ECMO support (44.4% vs 27.5%; p < 0.001), and higher in-hospital mortality (50.2% vs 34.5%; p < 0.001). Further, patients with COVID-19 were more likely to experience mechanical and clinical complications (membrane lung failure, pneumothorax, intracranial hemorrhage, and superimposed infection). After adjusting for pre-ECMO disease severity, patients with COVID-19 were more than two times as likely to die in the hospital compared with patients with non-COVID-19 viral ARDS.

Conclusions: Patients with COVID-19 that require ECMO have longer duration of ECMO, more complications, and higher in-hospital mortality compared with patients with non-COVID-19-related viral ARDS. Further study in patients with COVID-19 is critical to identify the patient phenotype most likely to benefit from ECMO and to better define the role of ECMO in the management of this disease process.

Keywords: COVID-19; extracorporeal membrane oxygenation; respiratory distress syndrome; respiratory insufficiency; viral pneumonia.